Effective interventions are urgently needed to promote adherence to life long treatment for women living with HIV. An estimated 30% of women seen at antenatal clinics in Johannesburg, South Africa are HIV-positive, and treatment challenges for women needing antiretroviral therapy (ART) during the postpartum period are myriad and poorly understood. The proposed study will use formative research methods to develop and pilot test an intervention to optimize treatment adherence among postpartum women on ART at the Perinatal HIV Research Unit (PHRU) treatment clinics in Soweto, South Africa. The Specific Aims of the study are: 1) To identify key contextual factors that influence HIV treatment adherence for mothers in the postpartum period, as guided by the Ecocultural Model of the family; 2) To develop a theory-based intervention that addresses contextual factors at the level of the individual and the family to improve medication adherence and follow up visit adherence among postpartum mothers on ART; and 3) To pilot test the intervention using a randomized pre-post test design a sample of 60 postpartum women on ART and a usual care control group (n=60) to assess feasibility, acceptability and potential efficacy, and to inform the development of a future randomized controlled trial (RCT) of the intervention. We will use qualitative interviews with HIV-positive mothers as well as their families, male partners, and health care providers to identify motivators and barriers to maternal treatment adherence. This will inform the development, design, and pilot testing of a theory-based intervention to optimize ART medication and follow up visit adherence for HIV-positive postpartum women in PHRU treatment programs. This research will build on the Principal Investigator's past training by drawing upon an outstanding mentoring and patient oriented research environment, and allowing her to gain new skills in intervention design and evaluation in order to become an independent investigator conducting research to improve the health of women and families affected by HIV. [unreadable] PUBLIC HEALTH RELEVANCE: Effective interventions to improve adherence to HIV treatment are urgently needed for postpartum HIV-positive women in South Africa. The goal of this study is to better understand barriers and motivators of maternal adherence, and develop an effective and culturally appropriate intervention to optimize adherence among postpartum mothers on treatment. [unreadable] [unreadable] [unreadable]